Increased longevity is one of the most remarkable success stories in human history. However, it leads to several challenges. One of them is the rise in the number of older people in need of long-term care. In almost all European countries, the majority of care is provided by the family members, in particular where the level of professional formal care is limited.
Being a caregiver is definitely a demanding task. It is an emotional “roller coaster”. On the one hand, caring for the family member demonstrates love and it can be a very rewarding personal experience. On the other hand, inadequate resources, exhaustion, worry, and continuous care demands can be enormously stressful. Caregivers find their lives changing as their role and its responsibilities expand, and sometimes not in a positive way
Research suggests that informal caregivers have a heightened risk of poor physical and mental health, as well as increasing loneliness. Recent studies moreover have shown a strong association between the provision of formal long-term care services and caregivers’ quality of life. The point here is not just that family members are more likely to be providers of care where formal services are weak, but that the availability of formal services affects the experience of informal caregiving. In a nutshell, being in a country with more formal long-term caregiver options makes the caregivers happier, decreases their level of mental issues and loneliness and, in general, improves caregivers’ health. For example, it has been found that British caregivers have better health than those from Belgium, and the researchers in this case thought that this could be explained by the higher quality of long-term care services provided in Great Britain compared with the ones in Belgium . Analysis of a much larger sample of European countries has shown that caregivers are happier in the countries where the percentage of gross domestic product (GDP) spending on old-age and family-related issues is high.
More recently still, Melanie Wagner and Martina Brandt have published a study which exploits regional differences within countries to investigate the same issue. The analysis uses the fifth wave of the Survey of Health, Ageing and Retirement in Europe (SHARE, 2013), which has data on the population aged 50 and older from eleven European countries: Austria, Belgium, Czech Republic, Denmark, Estonia, France, Germany, Italy, Luxembourg, Spain and Switzerland. They analyse data for a total of 138 sub-national regions within the SHARE participating countries The provision of formal care is measured by simple statistics on the supply of available long-term care beds in residential care facilities and nursing homes within a region. Their analysis also takes into account additional important characteristics of the individuals in the sample (all spouses), caregivers and non-caregivers alike, such as gender, age, education, financial situation, employment status, number of children, physical health, religiosity, household size, access to public services and the economic wealth of a region (GDP per capita).
In line with the previous studies on this topic, their results suggest that the spousal caregivers reported, on average, a lower level of life satisfaction, a higher degree of loneliness, less sense of control and more depressive symptoms than non-caregiving spouses. Importantly, the authors found that the local availability of formal long-term care services was correlated with various measures of well-being for spousal caregivers, but not for non-caregivers. In other words, spousal caregivers were more satisfied with life, less depressed and less lonely (when services for long-term care were available in their region. As the authors suggest, an important part of the explanations for these findings is likely to be that the presence of formal care services decreases the level of stress of caregiving spouses since they could count on a professional support. They also want to highlight the importance of the caregivers’ sense of control for their wellbeing: the ability to complement informal care with formal care may enhance well-being because it enables them to feel more in control of the caregiving role.
Overall, the existing studies indicate that the availability of formal care is beneficial not only for the care recipients themselves, but also for their caregiving partners. Developing formal care services that can support family caregivers, and if need be provide substitutes for informal care, must be a key factor in improving caregivers’ well-being. We can be reasonably confident that this will become even more important in coming years, as the availability of potential family caregivers continues to decline due to the higher mobility of younger generations, lower fertility rates, and increasing female labour force participation. For local governments the lessons seem clear: developing appropriate and responsive formal long-term care services can actively influence the conditions for healthy ageing in the entire population.
About the Author:
Dr Sara Zella is a Research Fellow at the Oxford Institute of Population Ageing. Sara joined the Institute in 2016 to work with Professor Sarah Harper on the research project “The impact of different work/care life courses on women’s wellbeing and quality of life in early retirement and the welfare regimes which help shape this”.
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